Skilled Care for Medicare Members

Date Issued: 10/27/2017

In August 2017, the Centers for Medicare & Medicaid Services (CMS) clarified standards that govern how skilled care is covered for Medicare members.

When skilled care is needed to maintain or prevent the worsening of a patient’s condition, skilled nursing care and skilled therapy services for Medicare members are covered under the following benefits:

  • Skilled nursing facility.
  • Home health care.
  • Inpatient rehabilitation facility.
  • Outpatient therapy.

This is the case as long as all other coverage criteria are met. Note that coverage cannot be denied even if there is no potential for improvement or restoration.

For full details please see the below.

MLN Matters Article Download (PDF)